- Amnion
- fluid filled sac surrounding embryo
- Amount of menstural flow
- 25-60ml per period
- Assessment Dx for infertility
- Physical exam, semen analysis, post coital test, sperm penetration assay
Evaluation of ovulation
Basal body temperature
Endometrial biopsy
Mittelschmerz, spinnbarkeit & fern test
Evaluation of pelvis
Hysterosalpingogram (HSG)
Laparoscopy - Causes of infertility
- - delayed age for family
- genetic and chromosomal abnormalities
- environmental factors: radiation, drugs, smoking, etc. - Cervical mucus method
- assessment of cervical mucus changes. At ovulation, mucus is clearer, and stretchy (spinnbarkeit) and more permeable to sperm. Luteal phase, mucus is thicker trapping sperm.
- Chlamydia
- may cause infection in neonates
- Chorion
- develops from chorionic villi; inner layer adheres to amnion; outer layer adheres to decidua
- Dizygotic (fraternal)
- 70%; originate from 2 separate zygotes
- Douching after intercourse
- not recommended. May push sperm higher.
- Dysmenorrhea
- painful menstruation
- EMBRYONIC PERIOD
- Development is cephalo-caudal pattern.
Tubular heart begins beating by end of 4th week.
Organogenesis: Marks the period from 4th-8th weeks- major organ formation occurs; embryo most vulnerable to toxic substances. Most congenital malformations occur at this period - Emergency contraception
- Previn & Plan B
- endometrial cycle - 4 phases
- menstural
proliferative
secretory
ischemic - Endometriosis (med)
- Danazol
- Estrogen
- secreted in large amounts by the ovaries in non-pregnant women.
Controls the development of the female secondary sex characteristics: breast, hips, and fatty deposits.
Assist in maturation of ovarian follicles
Cause uterus to increase in size and wt.
Estrogen inhibits FSH production and stimulates LH production. - FEMALE factors associated with infertility
- - infections: adhesions, scarring
- endometriosis: presence of endometrial tissue outside uterine cavity
- structural disorders: bicornate, septate uterus
- ovulatory factor: anovulation
- cervical factor: poor cervical mucus - FETAL PERIOD
- End of the 8th week to birth.
Characterized by maturation of tissues, organs and rapid body growth.
- First Trimester Abortion
- Vacuum aspiration, Methotrexate & Misoprostal (RU 486) prevents implantation
- follicular phase
- days 1-14
- Germ Layers
- all tissues and organs develop from the ectoderm, endoderm, and mesoderm
- Hypothalamic-pituitary
- Hypothalamic releases gonadotropin-releasing hormones (GnRH) due to low levels of estrogen and progesterone stimulating the pituitary to release Follicle stimulating hormones (FSH) starting the follicular phase (days 1-14), and then the lutenizing hormone is released starting the luteal phase (days 15-28)
- Increases in ______ ______ is essential to ovulation
- follicular maturation
- Length of menses
- 2-8 days usually (this may vary)
- MALE factors associated with infertility
- Sperm production - decreased, may be due to infection, mechanical problems, environmental influences
- sperm motility and transport - Menorrhagia
- Abnormal Uterine bleeding
- menstruation controlled by feedback system of 3 cycles
- endometrial
hypothalmic-pituitary
ovarian - Mensturation Cycle Length
- 1st day of one period to first day of next period (21-35 days)
- Monozygotic (identical)
- 30%; result from fertilization of one ovum which splits to form 2 separate zygotes
- Ovarian Cycle
- the follicular phase matures the follicle and near ovulation there is an estrogen surge. This phase varies the most in length. Once ovulation has occurred the progesterone is increase in preparation of a pregnancy this is the luteal phase which maintains the corpus luteum
- Ovum (oocyte) survives ___ hours
- 12-24
- Ovum contains __ autosomal chromosomes plus one ___ sex chromosome.
- 22; X
- Premenstrual syndrome
- associated with luteal phase (2 wks prior to onset)
- primary amenorrhea
- not established
- PRIMARY infertility
- inability to conceive
- Progesterone
- secreted by the corpus luteum and is found in greatest amounts during the secretory phase.
Decreases uterine motility and contractility preparing uterus for implantation.
Prepares breasts for lactation
(Temp rise in ovulation due to progesterone)
- Rhythm method
- identify the fertile phase
- Second Trimester Abortion
- Dilate & Evacuate
Hypertonic and uterotonic agents- Saline solutions
- secondary amenorrhea
- may be caused by pregnancy, lactation, hormonal imbalances, poor nutrition, exercise, etc.
- SECONDARY infertility
- inability to conceive after one or more successful pregnancies
- Sexually Transmitted diseases
- Chlamydia;
Chlamydia- may cause infection in neonates
Gonorrhea- may lead to PID or pelvic abscess leading to infertility; asymptomatic
Pelvic Inflammatory disease
Human papillomavirus (genital warts) - linked to ca of cervix, vagina, vulva, anus and penis. May impede vaginal delivery
Herpes Simplex Virus Type 2 Infection- may recur throughout lifetime linked to cervical ca.
Viral Hepatitis
HIV- increasing in heterosexual population; perinatal transmission may occur.
Vaginitis- Trichomonas, Gardnerella, and Candida albicans (thrush). Vaginal discharge, itching, burning
Human papillomavirus (genital warts) - linked to ca of cervix, vagina, vulva, anus and penis. May impede vaginal delivery
Herpes Simplex Virus Type 2 Infection- may recur throughout lifetime linked to cervical ca.
Viral Hepatitis
HIV- increasing in heterosexual population; perinatal transmission may occur.
Vaginitis- Trichomonas, Gardnerella, and Candida albicans (thrush). - Sperm contains __ autosomal chromosomes plus one ____ chromosome.
- 22; X or Y
- Sperm survive up to ___ hrs in the female reproductive tract
- 72
- STERILITY
- absolute inability to conceive
- Treatment of infertility (1)
- Pelvic factor etiology
Medical; Danazol (synthetic androgen)
Surgical: Obliteration endometrial implants
Ovulatory factor etiology
Pharmacological- includes clomiphene citrate (Clomid), human menopausal gonadotropin (hMG, Pergonal), Palodel, Metrodin (FSH)
Cervical factor etiology
Estrogen- increases cervical mucus
Male factor infertility
Lifestyle/environmental changes
Surgery (varicocele)
Artificial insemination (for low sperm count) - Treatment of infertility (2)
- Assisted reproductive technology
In vitro fertilization- embryo transfer
Ovum transfer- donor female
Gamete intrafallopian transfer (GIFT)
Zygote intrafallopian transfer (ZIFT)
Psychologic & cultural aspects of infertility
Emotions include: surprise, denial, anger, guilt, grief, isolation
Infertility represents a major life crisis for families
Religious and family beliefs
National support groups such as RESOLVE, exist to assist couples in dealing with infertility
Components of Sexual History
General physical, developmental, lifestyle factors
Psychosocial factors
Past sexual activity
Current sexuality related to childbearing
Adoption
Surrogate mothers - Vaginitis- Trichomonas, Gardnerella, and Candida albicans (thrush).
- Vaginal discharge, itching, burning
- Weeks 13-16
- lanugo develops, increased fetal activity, urine formed by kidneys
- Weeks 17-20
- Quickening occurs, vernix caseosa and brown fat form
- Weeks 21-24
- Alveoli develop
- Weeks 25-28
- Survival possible
- Weeks 29-32
- increased subcutaneous fat
- Weeks 33-36
- Surfactant maturity
- Weeks 37-40
- Full term at 38 weeks
- Weeks 9-12
- human appearing face, sex determination apparent
- ____ carries deoxygentated blood from the fetus to the placenta
- arteries
- ____ carries oxygenated blood from placenta to fetus
- vein
- ______ surrounds the blood vessels in the placenta
- wharton\'s jelly
